More ominously, a man standing just beyond the TV cameras apparently suffered a heart attack 20 minutes after event began. Medical personnel from the Capitol physician's office -- an entity that could, quite accurately, be labeled government-run health care -- rushed over, attaching electrodes to his chest and giving him oxygen and an IV drip.

This turned into an unwanted visual for the speakers, as a D.C. ambulance and firetruck, lights flashing, pulled in just behind the lawmakers. A path was made through the media section, and the patient, attended to by about 10 government medical personnel, was being wheeled away on a stretcher just as House Minority Leader John Boehner (R-Ohio) stepped to the microphone. "Join us in defeating Pelosi care!" he exhorted. A few members stole a glance at the stretcher. Boehner may have been distracted as well. He told the crowd he would read from the Constitution, then read the "we hold these truths" bit from the Declaration of Independence.

10 comments:

A more ardent supporter of such convictions would wear a "Medic Alert" bracelet prominently emblazoned with the letters "DNR" or at least demand a huge bill for the procedure. Do these people think that if Nathan Hale were alive today that he would be saying "Give me outrageous medical expenses or give me death!"?

Hopefully the snark will sustain you when the combination of unconstrained liability, financial penalties for deviation from rigid protocols, and inevitable reductions in your compensation manifest themselves.

financial penalties for deviation from rigid protocols, and inevitable reductions in your compensation

As someone who pays nearly three grand a month for her family's health insurance; whose Rx co-pays now top four hundred dollars a month for the kids alone; and who has to battle to get even *partial* reimbursement for care our doctors give out, who regularly receives letters from said insurer telling me to "tell my doctor" to change to such-and-such medicine, and whose doctors' decisions are guided by that which they've been told to perform or prescribe by the insurers, who also determine how many patients they must see in a given amount of time and how long they may spend on each one, I'd say the new bill--if it moves us toward the kind of care people receive in every other civilized country in the world--will be a huge improvement.

As for "unconstrained liability", is that not already upon us under the private system? And hasn't it been proven, over and over, that malpractice awards account for a fraction of the nation's healthcare expenditures, particularly when you compare them to executive compensation and staggering insurance company profits? But hey, why let logic and facts get in the way of a cowardly effort to anonymously inject (yet again) a tired wingnut talking point into the discussion.

I want to limit or eliminate the role of third party payers (this includes both insurance companies and the government) in as many medical decisions as possible. This legislation does precisely the opposite by mandating a dramatic shift towards comprehensive, first-dollar coverage for everyone that will dramatically increase total spending and do nothing but exacerbate the current cost-spiral.

Speaking of which what - precisely - are the mechanisms by which this bill will reduce the cost of care? E.g. how will expanding access to the same cost structure, while adding subsidies, and further distorting the micro-economic incentives that make consumers price-insensitive lead to a reduction in costs? Let me know if I need to restate the distinction between prices and costs.

As for the studies that have "proven" that liability has no effect on the cost of medicine, let's break that down a bit.

Firstly - if there's a study out there that actually purports to tally the costs of our current malpractice regime by adding up the total value of premiums plus payouts and dividing that by total spending - that's incredibly amusing - and speaks to the credulity of both review panels and erstwhile "reformers." That's as silly as tallying up the cost of airplane hijackings solely in terms of additional premiums and payouts. Think very hard for a moment and see if you can identify any additional costs borne by travelers as a consequence of hijackings.

Then ask yourself (and every physician that you come in contact with) if the current liability regime affects their behavior in ways that generate costs that aren't captured in stats that confine themselves to premiums and payouts. Maybe some expensive diagnostics that they had good reason to believe had little medical utility, but were quite useful for shielding them from liability. Any guesses as to what the total tab for such decisions might be?

It might also be worth asking whether the prospect of time, stress, and uncertainty of a jury trial that they wind up prevailing in has the potential to create incentives that affect their practice without costing them a dime.

The conviction that things can't get any worse as a result of legislation is a manifestation of an innocence so touching that it brings a tear to my eye. Hopefully that, and the consolations of snark, will see you all through.

For a person who pays $3k a month for health insurance would you rather pay $5k a month? This bill will most definitely increase the cost of healthcare for all people. It's another aspect of the redistribution of wealth that people seldom talk about, and it's another example of unintended consequences that won't be realized until this bill is passed.

By getting rid of the "pre-existing conditions" clauses and forcing the insurers to cover everyone, insurers will increase the costs of health insurance for everybody. For those people that are extremely sick and require $1 million in treatment where do you think the costs are going to be shifted? Everybody else. Healthy people end up paying for the sickest people that costs the most money.

What about the public option? In the House bill, it's a bit of a joke because the administration admits that it's only going to cover 2% of the population AND it's costs are going to be comparable to other insurance costs. So what's the point of passing bill? Well I suppose down the line, the government can just pour some more money into the public option. It's also possible that the government puts so much money into the public option that it can crowd out the "competition" and establish a monopoly (aka single payer system).

Here's your answer concerning the political calculus behind the current bill:

" The U.S. government is making a costly and open-ended commitment to help provide health coverage for the vast majority of its citizens. I support this commitment, and I think the federal government's spending priorities should be altered to make it happen. But let's not pretend that it isn't a big deal, or that it will be self-financing, or that it will work out exactly as planned. It won't.

Many Democratic insiders know all this, or most of it. What is really unfolding, I suspect, is the scenario that many conservatives feared. The Obama Administration, like the Bush Administration before it (and many other Administrations before that) is creating a new entitlement program, which, once established, will be virtually impossible to rescind. At some point in the future, the fiscal consequences of the reform will have to be dealt with in a more meaningful way, but by then the principle of (near) universal coverage will be well established. Even a twenty-first-century Ronald Reagan will have great difficult overturning it.

That takes me back to where I began. Both in terms of the political calculus of the Democratic Party, and in terms of making the United States a more equitable society, expanding health-care coverage now and worrying later about its long-term consequences is an eminently defensible strategy. Putting on my amateur historian's cap, I might even claim that some subterfuge is historically necessary to get great reforms enacted. But as an economics reporter and commentator, I feel obliged to put on my green eyeshade and count the dollars."

Gentlemen--and I say this straight-up, with no snark: I appreciate your efforts to educate me. But they're not necessary.

I'd ask where you and your calculators were hiding when the previous president saw fit to wage that rather costly war that helped not a single American and cost many thousands of them lives and limbs. Mostly, though, I'm amused (and kind of impressed) at the way you conveniently sidestep the real issues here: a) that every other civilized nation in the world having figured this out, thus offering either single-payer or some version of private/public/subsidized healthcare to *all* its citizens b) that the vice-grip the insurance industry has on our legislators is the reason citizens of the United States do not enjoy the same benefits, or even respect, that citizens of said countries have, and finally c) that the CEO's and large-scale shareholders of said insurance companies make unconscionably outsized profits, profits that are directly connected to the extortionate premiums their companies charge consumers relative to every single denied or beaten-down payment to patients and physicians.

And before bleating the tired old "there's nothing wrong with making a profit, this is what capitalism is all about," etc., there is an argument--a strong one--to be made that when profits directly result from actions that cause harm and death, society has cause to look at a different way of doing things. One more time for the morally impaired, then: every other civilized nation in the world has figured this out.

I'd welcome both an empirical discussion about the average rate of profits of health insurers vs the average rate of profits in the economy, and a more abstract discussion about the role that profits and losses play in organizing economic activity. I find arguments that profits represent a fixed pool of wealth that can be seized and redistributed to be particularly entertaining, so if you want to move beyond value judgments and into economic analysis let me know.

With regards to the appeal to popularity that you're making as the central premise of your argument concerning health care - let's address specifics. The unitary model that you are appealing to doesn't exist. The "everyone else" that you are making reference to is composed of vastly different mechanisms for underwriting the costs of health care, each with varying modes of cost sharing and clinical efficacy, each with particular costs and benefits. There's no one model that "everyone else" is following to adopt - and I invite you to pick a particular, concrete model and we can discuss its particular merits vs alternatives. Save the moralizing for a sermon.

Speaking of which, if someone is opposed to achieving universal coverage through either an expansion of the existing system or through the adoption of a Canadian style system, that they are against universal coverage in principle. You know more know that than you know anything about my stance on Iraq. Leave the channeling to the folks at the psychic friends network.

I'm not sure what's larger - the glaring magnitude of the said non-sequiter that bordered on free association, or the fact that the bill that you are defending will exacerbate, rather than alleviate a great many of the features of the existing system that cause you so much distress.

Just do the math: At my pediatricians office there are 5 Dr. partners, four nurses and 6 (yes, six, 6, SIX) employees that handle the paperwork.

If every other major industrial nation on this planet can figure out healthcare, I would think that we could too. Without all the hyperbole would be nice too. Especially if we could get a House Minority Leader who could pronounce the word properly.

Shadowfax

About me: I am an ER physician and administrator living in the Pacific Northwest. I live with my wife and four kids. Various other interests include Shorin-ryu karate, general aviation, Irish music, Apple computers, and progressive politics. My kids do their best to ensure that I have little time to pursue these hobbies.

Disclaimer

This blog is for general discussion, education, entertainment and amusement. Nothing written here constitutes medical advice nor are any hypothetical cases discussed intended to be construed as medical advice. Please do not contact me with specific medical questions or concerns. All clinical cases on this blog are presented for educational or general interest purposes and every attempt has been made to ensure that patient confidentiality and HIPAA are respected. All cases are fictionalized, either in part or in whole, depending on how much I needed to embellish to make it a good story to protect patient privacy.

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